Family Support Reduces Suicide Risk During Gender Identity Milestones

For transgender children and adolescents, family support during critical moments of gender identity development reduces the risk for suicide attempts and running away from home. These study results were published in JAMA Pediatrics

Previous research has shown that transgender youth face significant mental health disparities, including higher rates of depression, anxiety, and suicidality. Therefore, identifying the key contributors and protective factors associated with mental health distress among transgender individuals during gender identity milestones can help improve health outcomes.

Therefore, researchers conducted a retrospective cohort study to examine 1) how gender identity milestones affect mental health trajectories among transgender children and adolescents and 2) how these effects differ based on family support levels. The researchers used data from the 2015 United States Transgender Survey to identify transgender individuals aged 4 to 18 years who began a gender identity milestone before 18 years of age. Gender identity milestones included feeling different in one’s gender, identifying as transgender, disclosing transgender identity, and living full-time as their identified gender. The outcomes of interest included a first attempt at suicide and the act of running away from home. The researchers also assessed family support (ie, supportive, neutral, and adverse groups), time of gender identity milestone initiation, and mental health outcomes. 

A total of 18,303 transgender individuals were included in the analysis, 56.2% of whom (n=10,288) were assigned female at birth and 80.7% (n=14,777) were White.

The researchers found that transgender children and adolescents who grew up with adverse families were more likely to report at least 1 suicide attempt by 18 years of age (41.5%), relative to neutral families (32.8%) and supportive families (22.5%). Further, identifying as transgender increased the likelihood of suicide attempts by 1.75 percentage points (95% CI, 0.47-3.03) for those raised in adverse families and 1.39 percentage points (95% CI, 0.72-2.05) in neutral families. In contrast, transgender children and adolescents in supportive families did not experience a significant increase in suicidality following this milestone.

The researchers also observed that transgender individuals were more likely to run away from home by 18 years of age when raised in adverse (13.1%) and neutral families (8%) compared with supportive families (1.3%). The milestone of living full-time as one’s gender identity notably increased runaway rates in adverse (5.33 percentage points) and neutral families (3.32 percentage points), but had minimal effect in supportive families (0.96 percentage points).

Early milestones, like identifying as transgender or disclosing this to others, were associated with worse mental health outcomes in adverse or neutral family support environments. However, these milestones did not adversely affect mental health among individuals in supportive families.

“Efforts of healthcare professionals, counselors, and other community leaders to help establish supportive relationships between transgender children and their parents are critical,” the researchers concluded.

Study limitations include potential recall bias, lack of control over time-variant factors, and the relatively heterogeneous demographics of the study sample.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Psychiatry Advisor